Madrigal et al reported the Choose Home Algorithm for identifying an older veteran who is at greater risk for long-term care or death. The authors are from the Providence VA Medical Center and Brown University.
Patient selection: veteran older than 44 years of age
Parameters:
(1) age in years
(2) marital status
(3) enrollment priority (service connected disability)
(4) homeless
(5) rural
(6) dementia
(7) Parkinson's disease or Huntington's chorea
(8) schizophrenia
(9) substance abuse disorder
(10) Care Assessment Need score
(11) cancer
(12) congestive heart failure
(13) fracture
(14) head injury
(15) lower limb amputation
(16) malnutrition
(17) multiple sclerosis
(18) obesity
(19) pressure ulcer
(20) seizures
(21) sepsis
(22) spinal cord injury
(23) stroke
(24) diabetes
(25) cost to VA per year
(26) number of acute hospital stays
|
Parameter |
Finding |
Points |
|
age |
< 50 years |
0 |
|
|
50 to 69 years |
1 |
|
|
70 to 79 years |
3 |
|
|
80 to 89 years |
6 |
|
|
>= 90 years |
9 |
|
married |
no |
1 |
|
|
yes |
0 |
|
enrollment priority p1a |
no |
0 |
|
|
yes |
1 |
|
homeless |
no |
0 |
|
|
yes |
1 |
|
rural |
no |
0 |
|
|
yes |
1 |
|
dementia |
no |
0 |
|
|
yes |
2 |
|
Parkinson's/Huntington |
no |
0 |
|
|
yes |
2 |
|
schizophrenia |
no |
0 |
|
|
yes |
1 |
|
substance use disorder |
no |
0 |
|
|
yes |
1 |
|
Care Assessment Need |
< 95% |
0 |
|
|
>= 95% |
1 |
|
cancer |
no |
0 |
|
|
yes |
1 |
|
congestive heart failure |
no |
0 |
|
|
yes |
2 |
|
fracture |
no |
0 |
|
|
yes |
1 |
|
head injury |
no |
0 |
|
|
yes |
1 |
|
lower limb amputation |
no |
0 |
|
|
yes |
1 |
|
malnutrition |
no |
0 |
|
|
yes |
1 |
|
multiple sclerosis |
no |
0 |
|
|
yes |
1 |
|
obesity |
no |
0 |
|
|
yes |
1 |
|
pressure ulcer |
no |
0 |
|
|
yes |
1 |
|
seizures |
no |
0 |
|
|
yes |
1 |
|
sepsis |
no |
0 |
|
|
yes |
1 |
|
spinal cord injury |
no |
0 |
|
|
yes |
1 |
|
stroke |
no |
0 |
|
|
yes |
1 |
|
diabetes |
no |
0 |
|
|
yes |
1 |
|
cost (VA/FEE) |
< $50,000 |
0 |
|
|
>= $50,000 |
1 |
|
acute hospital stay |
0 |
0 |
|
|
>= 1 |
1 |
where:
• The marital status appears to give 1 point for being married. However, the estimate is negative and odds ratio 0.7.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 37 (paper says 47)
• The higher the score the greater the risk for long term care or death.
|
Total Score |
Risk Group |
|
0 to 3 |
low |
|
4 to 8 |
intermediate |
|
9 to 12 |
high |
|
>= 13 |
very high |
Performance:
• The area under the ROC curve is 0.80.
